Medical interns’ indifferences to clinical practice of lemology and changes in infec-tious disease spectrum were analyzed at present. Practical applicability of lemology knowledge should be defined clearly for medical interns in entrance education. Concepts of disinfectant and isolation should be enhanced. Clinical competence,communication skill with patients and medical ethics of medical interns should be cultured in order to achieve better clinical practice and teaching effect.

OBJECTIVE To study the differences of quinolones-resistant determining region(QRDR) in DNA gyrase A(gyrA) subunit between drug-resistant Klebsiella pneumoniae induced by fluoroquinolone in vitro and strains isolated from clinical isolates.Furthermore,to reveal the relation between different QRDR gene mutations and drug-resistance. METHODS Ten sensitive K.pneumoniae strains were selected and induced into drug-resistant strains by ciprofloxacin.The QRDR in gyrA by polymerase chain reaction(PCR) was amplified and compared their DNA sequences with clinically isolated quinolone-resistant K.pneumoniae. RESULTS We had found several gene mutations of QRDR in fluoroquinolone-resistant K.pneumoniae induced by ciprofloxacin,including Ser 83(TCC)→Phe(TTC) and Ile(ATC);and Gln106(CAG)→Leu(CTG).And the alteration of Gln106(CAG)→Leu(CTG) was a new discovery. CONCLUSIONS There are gene mutations of QRDR in fluoroquinolone-resistant K.pneumoniae induced by ciprofloxacin.The mutation of Ser 83(TCC) and Gln106(CAG) is probably the molecular basis of inducing drug-resistant strains.

This article talks about the importance of the cultivation of clinical cogitate ability in detail.Then the author did some useful research on how to guide,illume and direct the students to establish clinical cogitate ability during lemology practice,and made them have solid ground to be qualified doctors.The author poses that the cultivation of clinical cogitate ability must be rooted not in academic discussion but in teaching practice.

AIM: To compare the therapeutic effects, adverse reactions and the costs between recombinant human growth hormone(rhGH) and human serum albumin(HSA) in treatment of liver cirrhosis patients with hypoproteinemia METHODS: Using pharmacoeconomic cost-effectiveness analysis , rhGH was compared with HSA in treatment of 66 liver cirrhosis patients with hypoproteinemia(divided into two groups). RESULTS:After 4 weeks treatment, the effective rates of rhGH and HSA we- re 69.70% and 84.85%, the cost-effectiveness ratios were 27.36, 38.89, respectively. After 8 weeks treatment, the effective rates of rhGH and HSA were 78.79% and 54. 57% ,the cost-effectiveness ratios were 2420, 60.47, respectively. CONCLUSI- ON: rhGH can effectively treat liver cirrhosis with hypoproteinemia and can obviously increase serum albumin level. From a Long-term point of view, its cost effectiveness ratio is superior to that of HSA.

0 05),the cost-effectiveness ratios were 762 49 and 111 85 respectively(P

0.05).The effective rates of Somatostatin and Octreotide were 89.29% and 82.14%;the time averages for hemostasia were (15.67?7.34)hrs and (17.22?9.38)hrs respectively;the cost-effectiveness ratios were 51.54 and 65.94 respectively.For all-in cost of a therapeutic course,Octreotide group exceeded 814.34 yuans compared to Somatostatin group.The cost-effective ratios showed that the all-in costs of Somatostatin and Octreotide groups were 51.54 yuans and 65.94 yuans respectively in increase of 1% of effective rate with a difference of 14.4 yuans.CONCLUSION:Somatostatin is cheaper in cost and better in cost-effective ratio in comparison with Octreotide.

Objective To compare the cost-effectiveness of telbivudine-based optimization treatment and entecavir monotherapy in patients with HBeAg-positive chronic hepatitis B (CHB). Methods A Markov model for disease progression of CHB was constructed and cost-effectiveness analysis was conducted to estimate their long-term effects and medical costs. Results There were 36.11 expected life years (ELYs) and 23.08 quality adjusted life years (QALYs) gained from treatment with telbivudine optimization, which were longer than 35.95 ELYs and 23.08 QALYs from entecavir treatment. The total cost of telbivudine optimization was 348 863.62 yuan and that of entecavir treatment 349 279.27 yuan. Each extension of a QALYs required for medical expenses of 15 115.41 yuan in telvivudine optimization, which was cheaper than that in entecavir treatment with 15 225.77 yuan. Conclusions Telbivudine-based optimization treatment shows good cost-effectiveness than entecavir monotherapy. Telbivudine-based optimization treatment can be used as the optimum choice for antiviral therapy in CHB.

Objective To investigate the role and significance of E selectin in the pathogenesis of neonatal acute lung injury (ALI).Method Ninety neonatal Sprague Dawley (SD) rats (6 or 7 days after birth) were randomly assigned to the control group (n =10) and ALI group (n =80).The rats in the ALI group received intraperitoneal injection of lipopolysaccharide (LPS) at dose of 4 mg/kg and they were divided into eight subgroups with 10 rats in each group according to different sacrifice time (0.5 h,1 h,2 h,3 h,4 h,8 h,12 h and 24 h after injection).Rats in the control group were injected intraperitoneally the same volume of normal saline and they were sacrificed at 4 hours after injection.Expression of the E-selectin in lung tissue was detected dynamically by immunohistochemistry and the serum soluble endothelial selectin (sE-selection) was detected by enzyme-linked immunosorbent assay (ELISA).The pathological changes of the lung tissue and the wet/dry lung weight ratio (W/D ratio) were recorded.Result The strong expression of a large number of E-selectin was detected in the vascular endothelial cells of the lung tissue in the ALI group,while only moderate expression of E-selection was observed in the control group.The W/D ratio in the ALI group gradually increased from 0.5 h after intraperitoneal injection of LPS,reached the peak at 8 h,and then began to decline.The ratio was significantly higher in the ALI group than that of the control group from 4 to 12 h after injection (P ＜ 0.05).The mean optical density of E-selectin in lung tissue of ALI group was also higher than that of the control group and the average optical density of ALI group at 2 h,3 h,4 h and 8 h was significantly higher [2 h:(0.36 ±0.09),3 h:(0.38 ±0.01),4 h:(0.44 ± 0.06),8 h:(0.30 ± 0.09),control group:(0.24 ± 0.01),P ＜ 0.05].The level of serum sE-selectin gradually increased after intraperitoneal injection of LPS,reached the peak at 2 h,and then decreased gradually.The level of sE selection was significantly higher than that of the control group at the point of 2 h,3 h,4 h and 8 h (P ＜ 0.05).The level of serum sE-selectin increased along with the expression of E-selectin in lung tissues,and they were positively correlated (r =0.730,P ＜ 0.01).Conclusion The increased expression of E-selectin and the elevation of serum sE-selectin level may reflect the injury of pulmonary vascular endothelial cells induced by systemic inflammatory response.

Objective To observe the effects of Tangshenjiaonang (TSJN) on biochemistry, renal function and hemorheology of alloxan and achromycin induced diabetic nephropathy rats. Methods The diabetic nephropathy rats induced by alloxan and achromycin were divided into 5 experimental groups. compared with control group, to observe the changes of the indicators shown about. Results TSJN can significantly decrease the level of SCr, BUN, CCr, FIB, plasma viscosity and UAER (P

Objective To investigate the effects of hypoxia-inducible factor-1α (HIF-1α)expression on pathogenesis of retinopathy of prematurity (ROP) and to find new target for gene therapy.Methods After liposome-mediated small interference RNA (siRNA) transfection into rat retinal endothelial cells,the cells were cultured in medium with CoCl2-induced hypoxic condition.Expression of HIF-1α mRNA was determined by fluorenscence quantitative reverse transcription-polymerase chain reaction(RT-PCR),HIF-1α protein expression was detected by Western Blot after cocultured for 8 hours.Cell proliferation was measured with 3-(4,5)-dimethylthiazol (-2-yl)-2,5-diphenyltetrazolium bromide(MTT) assay after cocultured for 24 hours.Difference between groups was compared with independent samples t test.Results Rat retinal vascular endothelial cells were successfully transfected with siRNA.Fluorescence quantitative RT-PCR results showed that at 48 hours of transfection,the expression of HIF-1α mRNA in the interference group of siRNA1,siRNA2 and siRNA4 were 0.1620 ± 0.0147,0.2034 ± 0.0251 and 0.3049 ± 0.0165,which were 16.20％,20.34 ％ and 30.49％ of blank control group (1.0000±0.0344),and were lower than that of negative control group (0.8334±0.0242) (t=16.786,8.953 and 4.087,P＜0.05 respectively).Western Blot results showed that HIF-1α protein expression was significantly inhibited by siRNA1(0.4956 ± 0.0421 ) and siRNA2 (0.6544 ± 1.0032) comparing with blank control group (3.5105 ±0.4084) and negative control group (3.4019 ± 1.0677) (t =6.861,2.893,4.567 and 5.072,P＜0.05 respectively).As for cellular proliferation activity,(49.5±2.9) ％ and (67.4±1.2) ％ of cells growth inhibition were observed after transfection with siRNA1 and siRNA2,which were higher than those of negative control group [(15.7±1.5) ％ ] (t=2.786 and 6.904,P＜0.05).Conclusions The synthetic HIF-1α siRNA could effectively inhibit the expression of HIF-1α gene and reduce cell proliferation in rat retinal endothelial cells under hypoxic condition.RNA interference technology targeting HIF-1α might become a new strategy for gene therapy of ROP.